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At least 19 recordsLinked to original sources
PubMed2026

A flipped classroom approach compared with low-interactive online learning for pediatric pain management knowledge and instructional motivation in nursing students: A randomized controlled study.

AIM: This study aimed to compare a flipped classroom approach with low-interactive online learning in terms of nursing students' questionnaire-assessed pediatric pain management knowledge and instructional motivation. BACKGROUND: Pain management in children is a critical and multidimensional nursing responsibility. However, limited curricular time and opportunities for applied learning may restrict nursing students' preparedness in this area. Structured and interactive instructional formats, such as the flipped classroom, may support knowledge acquisition and motivation in pediatric nursing education. METHODS: This study employed a parallel-group randomized controlled trial design with a 1:1 allocation ratio. Eighty-eight third-year prelicensure nursing students were randomized to either the flipped classroom group (n = 44) or the low-interactive online learning group (n = 44). Due to attrition (2 intervention, 2 control), analyses included 42 participants per group (n = 84 in total). Data were collected between February and July 2022 using the Pediatric Pain Management Knowledge Scale for Nursing Students and the Instructional Materials Motivation Survey. This study was prospectively registered at ClinicalTrials.gov (Identifier: NCT07129044). RESULTS: At baseline, the groups were comparable in terms of knowledge and learning motivation. Following the intervention, the flipped classroom group demonstrated greater improvements in questionnaire-assessed pediatric pain management knowledge and instructional motivation than the low-interactive online learning group. Although scores declined from post-test to the three-month follow-up, they remained above baseline in the flipped classroom group. CONCLUSIONS: Within the context of this course, the flipped classroom approach was associated with greater improvement in questionnaire-assessed pediatric pain management knowledge and instructional motivation than low-interactive online learning. The findings should be interpreted as proximal educational outcomes rather than evidence of improved clinical competence or durable long-term effectiveness. Further studies using objective performance-based outcomes and longer follow-up periods are needed.

Humans↗
PubMed1979

Chronic pain: which patients may a pain-management program help?

To ascertain whether chronic-pain patients who are likely to benefit from a pain-management program can be identified before treatment, we studied for differences discernible at the beginning of treatment a group who succeeded and did well at 1-year follow-up (n = 34) and a group who failed (n = 35). The two groups differed significantly (P less than 0.01) in regard to duration of pain, work time lost, number of operations, subjective pain level, and drug dependency. Deviations on the MMPI were greater in failures than in successes; but the differences were not statistically significant. A 7-item rating scale based on these data differentiated a favorable group (including 71% of the successes) from an unfavorable group (including 86% of the failures). This scale should be helpful in selection of candidates for a pain-management program, even though it needs further validation.

Chronic Disease↗
PubMed2026

Comparative Evaluation of Virtual Reality versus Standard Nursing Care in Managing Pain and Fear during Lumbar Puncture Procedures: A Randomised Controlled Trial.

BACKGROUND: Meningitis is a serious infectious disease that can cause significant morbidity and long-term neurological problems. Although a lumbar puncture is a necessary diagnostic procedure, it is often accompanied by discomfort, anxiety, and fear, which can severely impact the patient's experience. Although there is few data on its application prior to lumbar puncture in adult patients with meningitis, immersive virtual reality (VR) has become a promising non-pharmacological technique for lowering procedural distress. Thus, among individuals undergoing lumbar punctures, this randomized controlled research assessed how well pre-procedural VR reduced pain, anxiety, and fear while enhancing patient satisfaction. OBJECTIVE: This study aims to evaluate the effectiveness of virtual reality (VR) in reducing pain and fear among adults undergoing lumbar puncture (LP) compared with standard care protocol. METHODS: A randomised clinical trial was conducted from May to October 2025, using a single-blind, true experimental design. A total of 85 patients were randomly assigned to either the VR intervention group ( n = 41) or the control group receiving standard care ( n = 44). Pain levels were assessed using a visual analogue scale. Fear was assessed using the Multidimensional Fear-of-Injection Scale. Data were analysed using SPSS version 26. RESULTS: According to the study, the findings revealed a significant reduction in pain levels among the study group following the VR intervention, with mean pain scores dropping from 7.54 ± 1.925 to 2.49 ± 0.675. In contrast, the control group showed increased pain intensity, with mean scores rising from 6.84 ± 1.842 to 8.36 ± 1.348. The VR group showed a significant reduction in fear scores across all domains, whereas no significant changes were observed in the control group. Direct fear decreased from 20.12 ± 1.71 to 9.44 ± 2.00, indirect fear from 17.24 ± 1.46 to 8.66 ± 2.24, physiological response improved from 0.34 ± 0.66 to 3.00 ± 1.00 and avoidance behaviour decreased from 16.71 ± 1.49 to 7.80 ± 1.85. CONCLUSIONS: The research shows that the use of VR prior to LP significantly reduces level of pain and fear compared to standard care. These results support VR as a non-pharmacological intervention for fear and pain to improve patient experience during invasive procedures. In contrast, the control group experienced no improvement.Trial Registration: The IRCT code for the trial was IRCT ID 20250803066743N1.

Humans↗
PubMed2026

Ibuprofen versus acetaminophen for acute mild-to-moderate pain management in pediatric populations: a systematic review and meta-analysis of their efficacy.

UNLABELLED: Ibuprofen and acetaminophen are the most widely used analgesics in pediatric practice for the management of acute mild-to-moderate pain. Despite their widespread use, the comparative analgesic efficacy of these two agents in children remains a subject of ongoing debate, with existing evidence largely derived from heterogeneous clinical settings and small individual trials. Therefore, this study aimed to systematically review and meta-analyze randomized controlled trials comparing the analgesic efficacy of ibuprofen versus acetaminophen in pediatric populations with acute mild-to-moderate pain. A systematic literature search was conducted up to May 2026 in PubMed, Scopus, and Web of Science. The review was conducted and reported in accordance with the PRISMA-Children and Adolescents (PRISMA-C) 2026 reporting guideline. Eligible studies were randomized controlled trials comparing ibuprofen with acetaminophen in children and adolescents (defined as individuals aged 0 to&#x2009;<&#x2009;18&#xa0;years) with acute pain, reporting at least one extractable efficacy outcome. Continuous outcomes were synthesized as standardized mean differences (Hedges' g) using random-effects models; dichotomous outcomes were pooled as risk ratios (RRs) with 95% confidence intervals. Risk of bias was assessed using the Cochrane RoB 2 tool and certainty of evidence was evaluated using the GRADE framework. Eight randomized controlled trials enrolling 1325 participants were included. Three pediatric trials contributed to the primary continuous pain outcome meta-analysis (n&#x2009;=&#x2009;196 analyzable participants), yielding a pooled SMD of&#x2009;-&#x2009;0.28 (95% CI&#x2009;-&#x2009;0.57 to 0.00; p&#x2009;=&#x2009;0.052; I2&#x2009;=&#x2009;0%), indicating a small effect favoring ibuprofen that did not reach conventional statistical significance. Given the small number of contributing studies (k&#x2009;=&#x2009;3), the I2 statistic should be interpreted with caution as it has limited power to detect heterogeneity in this context. For the dichotomous pain freedom outcome (2 trials, n&#x2009;=&#x2009;114), no significant difference was observed (pooled RR 1.03, 95% CI 0.53-1.99; p&#x2009;=&#x2009;0.93; I2&#x2009;=&#x2009;0%). A prespecified sensitivity analysis including an adult soft-tissue injury trial attenuated the pooled effect toward the null (SMD&#x2009;-&#x2009;0.15, 95% CI&#x2009;-&#x2009;0.38 to 0.09; p&#x2009;=&#x2009;0.23; I2&#x2009;=&#x2009;36.6%). Narrative synthesis of additional studies generally demonstrated comparable analgesic efficacy between the two agents across postoperative and outpatient pediatric settings. The overall certainty of evidence was rated as low for both primary outcomes, primarily due to imprecision and indirectness. CONCLUSION: Current evidence from randomized controlled trials does not demonstrate a superiority of ibuprofen over acetaminophen for acute mild-to-moderate pain management in children. Both agents appear to provide clinically meaningful analgesia across heterogeneous pediatric pain settings. The clinical choice between agents should be guided by individual patient factors, including contraindications to NSAIDs, the inflammatory nature of the pain etiology, and patient-specific characteristics. The low certainty of evidence underscores the need for adequately powered, methodologically rigorous trials to definitively establish the comparative efficacy of these two analgesics in the pediatric population. WHAT IS KNOWN: &#x2022; Ibuprofen and acetaminophen are the two most widely used non-opioid analgesics for acute mild-to-moderate pain in children, and both are recommended as first-line agents by major international guidelines. &#x2022; Prior meta-analyses in mixed pediatric-adult populations have suggested a modest analgesic advantage of ibuprofen over acetaminophen, but pediatric-specific evidence has remained limited and methodologically heterogeneous. WHAT IS NEW: &#x2022; This systematic review and meta-analysis, restricted to randomized controlled trials in pediatric populations, found that ibuprofen showed a small effect favoring pain reduction compared with acetaminophen (SMD&#x2009;-&#x2009;0.28, p&#x2009;=&#x2009;0.052), although this did not reach conventional statistical significance. &#x2022; The analgesic advantage of ibuprofen may be more pronounced in pain etiologies with a significant inflammatory component (e.g., fractures). At the same time, both agents appear broadly equivalent in most other acute pediatric pain settings, supporting individualized analgesic selection based on clinical context and patient-specific factors.

Humans↗
PubMed1978

Transcutaneous electrical nerve stimulation: an adjunct in the pain management of Guillain-Barré syndrome.

Transcutaneous electrical nerve stimulation was applied in the pain management of a patient with Guillain-Barré Syndrome. As subjectively reported by the patient, her back and lower extremity pain was significantly decreased although her foot paresthesia was not decreased. The program was continued for an 11-day period because TENS was considered a valuable adjunct for the patient's comfort. Transcutaneous electrical nerve stimulation is a valuable addition to our repertoire of available physical therapy modalities. We hope that as clinical experience with TENS increases, fellow clinicians will volunteer the experiences of their endeavors.

Adult↗
PubMed2026

Comparison of Ketamine and Pregabalin on Postoperative Opioid Usage and Pain Management in Spinal Fusion: Systematic Review and Network Meta-analysis.

BACKGROUND CONTEXT: Spinal fusion is associated with substantial early postoperative pain and opioid exposure. Both ketamine and pregabalin are widely incorporated into Enhanced Recovery After Surgery (ERAS) protocols as opioid-sparing adjuncts. However, their comparative efficacy and safety in this specific setting remain uncertain. Our objective was to compare ketamine and pregabalin indirectly for early postoperative opioid consumption, pain, and adverse events in adults undergoing spinal fusion. METHODS: Pubmed, Embase, and Cochrane Trials were searched from inception through October 2025. Eligible studies were randomized trials enrolling adults undergoing instrumented spinal fusion, randomized to perioperative ketamine, pregabalin, or control, and reported extractable 24-hour opioid consumption or pain outcomes. Continuous outcomes were pooled as mean differences in MME or VAS units, and adverse events were reported descriptively. A connected treatment network was analyzed using random-effects models. Risk of bias (RoB) was assessed with the Cochrane RoB 2 tool. RESULTS: Thirteen trials (n=879) were included: ketamine (n=210), pregabalin (n=271), and control (n=398). Six trials contributed opioid data (3 ketamine, 3 pregabalin). Using pregabalin 150 mg as reference, ketamine was associated with lower 0-24-hour opioid use (MD -56.99 mg MME; 95% CI -99.56 to -14.43). Control (MD +21.31; 95% CI -1.05 to +43.66) and pregabalin 300 mg (MD -13.22; 95% CI -40.41 to +13.96) did not significantly differ from pregabalin 150 mg. Seven trials contributed 24-hour VAS data, with control being associated with higher pain versus pregabalin 150 mg (MD +0.84; 95% CI +0.01 to +1.66), while ketamine and pregabalin 300 mg were not k significantly different. Adverse events were generally infrequent and similar to control. CONCLUSIONS: Both ketamine and pregabalin provide early opioid sparing with comparable 24-hour analgesia. Ketamine showed a larger opioid-sparing point estimate, but indirect comparisons are imprecise. Adequately powered head-to-head trials with standardized protocols and adverse event reporting are needed.

Humans↗
PubMed1979

Reinterpretative cognitive strategies in chronic pain management.

This preliminary study was conducted to test the effectiveness of cognitive treatment of clinical pain. Chronic pain patients were trained in a self-control cognitive strategy procedure. Specifically, they were provided with a conceptualization of their pain, instructed in an awareness of their thoughts prior to and during their experience of pain, and trained in the use of several cognitive strategies to replace these thoughts and relabel their pain experience. Training was provided in a group setting to further consolidate the use of the instructions by enabling patients to roleplay the instructions to one another. Patients were also encouraged to verbally reinforce themselves each time they used the procedure. The experience of pain was measured by the McGill pain questionnaire, a behavioral checklist and staff reports. Results suggest that cognitive strategies can effectively alter the experience of clinical pain. Moreover, pain as a cognitive label for a nonspecific state of arousal is suggested.

Cognition↗
PubMed1979

Principles of pain management. A short review.

Information that contributes to our understanding of the processes that participate in the perception of and responses to pain has expanded rapidly in the last decade. Much of this information and many clinical observations demand new conceptual frameworks within which to modify and expand classical teachings of pain pathways and mechanisms. In this brief review, some of these new dimensions are considered. The limited references serve as an introduction to more comprehensive original and review material.

Afferent Pathways↗
PubMed1978

The role of the anaesthetist in chronic pain management.

The role of the anaesthetist in the continuing care of patients suffering from chronic pain has been discussed. Many of the techniques, both invasive and non-invasive, which are currently available for the treatment of chronic pain have been reviewed.

Anesthesiology↗
PubMed1979

Medical management of chronic cancer pain.

Management of the chronic pain of cancer is a common and difficult problem. In addition to a medical examination of the patient, it is necessary to perform a psychological assessment of his premorbid personality, current mental status, and coping mechanisms to devise an individualized approach to his pain. The mainstay of cancer pain control are the narcotics, which differ primarily in potency and duration of action. Nonnarcotic analgesics are equianalgesic with the less potent narcotics. Antipsychotic drugs are useful as tranquilizers, antiemetics, and analgesic potentiators. Antidepressants and hypnotics permit the patient a more normal life-style. Stimulants such as cocaine and amphetamines both potentiate narcotic analgesia and reduce narcotic-induced somnolence and respiratory depression. Tetrahydrocannabinol offers no advantage over traditional analgesics. With care and patience, the physician can render practically any cancer patient pain-free.

Analgesics, Opioid↗
PubMed1975

The medical approach to management of pain caused by cancer.

Every physician at some time must manage pain associated with advanced cancer. In spite of the hopeless prognosis, the problem of pain deserves an intelligent appraisal and a systematic plan for relief to conserve the patients's physical, mental, and moral resources and social usefulness as long as possible. Selection of a method of tumor therapy from an array of laternatives demands study of the individual patient and careful consideration of the appropriate measures-the possibilities for success and the limitations, benefits, and risks.

Analgesics↗
PubMed1979

Arterial occlusion in the management of pain from metastatic renal carcinoma.

Arterial embolization was performed in nine patients with metastases from renal carcinoma who had severe pain resistant to conventional therapy. Patients with metastases in the ilium (four), the lumbosacral spine (one), and the base of the skull (one) experienced pain relief lasting from one to six months. The other three patients, who had metastases in the proximal femur, underwent preoperative embolization to facilitate tumor curettage and internal hip fixation. No significant complications were seen with this therapeutic approach.

Aged↗
PubMed1977

Psychological, physiological, and pharmacological management of pain.

It has been the intent of the authors to impress upon the clinician the multifaceted nature of the human pain experience. We have sought to create an understanding of the emotional nature of pain. The treatment of pain as a pure sensation without directing attention to its behavioral and psychological aspects will generally lead to failure in understanding and ultimately in treating this ubiquitous problem in our profession. The use of drugs alone will have only a minor effect on the treatment of pain. Knowledge of environmental control and an understanding and empathetic approach to the patient in pain or in stress will carry the dentist a long way toward his goal of dental treatment without pain or emotional upset.

Age Factors↗